Study of the effect of post-traumatic stress disorder and comorbid disorders on the daily lives of schoolchildren aged 11 to 16 in public schools in Morocco
Słowa kluczowe:
prevalence, school-age, post-traumatic stress disorder, traumatic occurrences, associated disordersAbstrakt
Background:
Post-traumatic stress disorder (PTSD) can develop after exposure to traumatic events such as those involving actual or threatened death, serious injury, or sexual violence. This survey was conducted to assess the prevalence of PTSD among adolescents attending public schools in the city of Salé in Morocco and to study the levels of anxiety and depression – the most common disorders associated with PTSD.
Participants and procedure:
Based on a cross-sectional survey, 900 schoolchildren with an age between 11 and 16 years old were selected. The percentage of participants who agreed to take part was 89%. The validated questionnaires (socio-demographic data, list of life events, CPTS-RI, CDI and STAIY) were completed by the schoolchildren. Using SPSS statistical software, Student’s t-test, Cohen’s d test, chi-square (χ2), Cramer’s V, and Pearson’s correlation (r) were calculated. The research project began after receiving research authorization from the Ministry of National Education, and consent forms were signed by partici-pants.
Results:
The prevalence of PTSD was 31.7%. Factors such as adolescent developmental characteristics, socioeconomic status, and parental education level may contribute to the observed prevalence. A higher percentage of this disorder was observed in girls (60.7%) than in boys (39.3%) (p = .008, d = 0.75). This prevalence reflects the proportion of schoolchildren currently exhibiting PTSD symptoms. Among participants, 77.2% exhibited anxiety symptoms and 51.3% exhibited depressive symp-toms.
Conclusions:
PTSD has negative consequences for the well-being of school-age adolescents, affecting their emotional, social, and aca-demic functioning. Interventions are available to treat this disorder in affected adolescents. Adolescents with PTSD should have access to professional psychological care from trained specialists, as well as support from their families.
Downloads
Bibliografia
Ainamani, H. E., Weierstall-Pust, R., Bahati, R., Otwine, A., Tumwesigire, S., & Rukundo, G. Z. (2022). Post-traumatic stress disorder, depression and theassociated factors among children and adolescents with a history of maltreatment in Uganda. European Journal of Psychotraumatology, 13, 2007730. https://doi.org/10.1080/20008198.2021.2007730
Alkharashi, Y. M., Alrasheed, F., Alhussaini, N., Almosa, A., Alkharashi, N., & Alsalamah, M. (2022). Prevalence of post-traumatic stress disorder among all emergency workers at Saudi tertiary care center in Riyadh, Saudi Arabia. Journal of Pharmaceutical Research International, 34, 1–10. https://doi.org/10.9734/jpri/2022/v34i597264
Alzaghoul, A. F., McKinlay, A. R., & Archer, M. (2022). Post-traumatic stress disorder interventions for children and adolescents affected by war in lowand middle-income countries in the Middle East: Systematic review. BJPsych Open, 8, e153. https://doi.org/10.1192/bjo.2022.552
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). APA Publishing.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed., text revision). APA Publishing.
Amin, R., Nadeem, E., Iqbal, K., Asadullah, M. A., & Hussain, B. (2020). Support for Students Exposed to Trauma (SSET) program: an approach for building resilience and social support among flood impacted children. School Mental Health, 12, 493–506. https://doi.org/10.1007/s12310-020-09373-y
Anderson, T. L., Valiauga, R., Tallo, C., Hong, C. B., Manoranjithan, S., Domingo, C., Paudel, M., Untaroiu, A., Barr, S., & Goldhaber, K. (2025). Contributing factors to the rise in adolescent anxiety and associated mental health disorders: a narrative review of current literature. Journal of Child and Adolescent Psychiatric Nursing, 38, e70009. https://doi.org/10.1111/jcap.70009
Assmann, N., Fassbinder, E., Schaich, A., Lee, C. W., Boterhoven de Haan, K., Rijkeboer, M., & Arntz, A. (2021). Differential effects of comorbid psychiatric disorders on treatment outcome in posttraumatic stress disorder from childhood trauma. Journal of Clinical Medicine, 10, 3708. https://doi.org/10.3390/jcm10163708
Astitene, K., Aguenaou, H., Lahlou, L., & Barkat, A. (2020). Prevalence of post-traumatic stress disorder among school-age adolescents. International Neuropsychiatric Disease Journal, 14, 40–49. https://doi.org/10.9734/INDJ/2020/v14i130121
Astitene, K., & Barkat, A. (2021). Prevalence of posttraumatic stress disorder among adolescents in school and its impact on their well-being: a crosssectional study. Pan African Medical Journal, 39, 54. https://doi.org/10.11604/pamj.2021.39.54.27419
Astitene, K., & Barkat, A. (2022). The prevalence and impact of post-traumatic stress disorder among Moroccan adolescents enrolled in public high schools in Salé: a cross-sectional study. Archives of Psychiatry Research, 58, 81–90. https://doi.org/10.20471/may.2022.58.01.09
Basedow, L. A., Wiedmann, M. F., Roessner, V., & Golub, Y. (2022). Coping motives mediate the relationship between PTSD and MDMA use in adolescents with substance use disorders. Addiction Science & Clinical Practice, 17, 46. https://doi.org/10.1186/s13722-022-00329-y
Borst, B., Jovanovic, T., House, S. L., Bruce, S. E., Harnett, N. G., Roeckner, A. R., Ely, T. D., Lebois, L. A. M., Young, D., Beaudoin, F. L., An, X., Neylan, T. C., Clifford, G. D., Linnstaedt, S. D., Germine, L. T., Bollen, K. A., Rauch, S. L., Haran, J. P., Storrow, A. B., Lewandowski, C., … van Rooij, S. J. H. (2024). Sex differences in response inhibition-related neural predictors of posttraumatic stress disorder in civilians with recent trauma. Biological Psychiatry, 9, 668–680. https://doi.org/10.1016/j.bpsc.2024.03.002
Boudabous, J., Kerkeni, A., Kraiem, M., Ayadi, H., & Moalla, Y. (2023). Post-traumatic stress disorder in adolescents during the COVID-19 pandemic: a cross-sectional Tunisian study. Middle East Current Psychiatry, 30, 101. https://doi.org/10.1186/s43045-023-00373-7
Brewin, C. R., Atwoli, L., Bisson, J. I., Galea, S., Koenen, K., & Lewis-Fernández, R. (2025). Posttraumatic stress disorder: Evolving conceptualization and evidence, and future research directions. World Psychiatry, 24, 52–80. https://doi.org/10.1002/wps.21269
Brown, P. J., Read, J. P., & Kahler, C. W. (2003). Comorbid posttraumatic stress disorder and substance use disorders: Treatment outcomes and the role of coping. In P. Ouimette & P. J. Brown (Eds.), Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders (pp. 171–188). American Psychological Association. https://doi.org/10.1037/10460-009
Christoffersen, M. N., & Thorup, A. A. E. (2024). Posttraumatic stress disorder in school-age children: a nationwide prospective birth cohort study. Journal of Child & Adolescent Trauma, 17, 139–157. https://doi.org/10.1007/s40653-024-00611-y
Chossegros, L., Hours, M., Charnay, P., Bernard, M., Fort, E., Boisson, D., Sancho, P. O., Yao, S. N., & Laumon, B. (2011). Predictive factors of chronic posttraumatic stress disorder 6 months after a road traffic accident. Accident Analysis & Prevention, 43, 471–477. https://doi.org/10.1016/j.aap.2010.10.004
Clarke, A. T., Grassetti, S. N., Brumley, L., Ross, K. Y., Erdly, C., Richter, S., Brown, E. R., & Pole, M. (2023). Integrating trauma-informed services in out-of-school time programs to mitigate the impact of community gun violence on youth mental health. Journal of Prevention & Intervention in the Community, 51, 332–351. https://doi.org/10.1080/10852352.2024.2313382
Costello, E., Erkanli, A., Fairbank, J. A., & Angold, A. (2002). The prevalence of potentially traumatic events in childhood and adolescence. Journal of Traumatic Stress, 15, 99–112. https://doi.org/10.1023/A:1014851823163
Craig, C. D., & Sprang, G. (2014). Gender differences in trauma treatment: Do boys and girls respond to evidence-based interventions in the same way? Violence and Victims, 29, 927–939. https://doi.org/10.1891/0886-6708.VV-D-13-00016
Deering, C. G. (2000). A cognitive developmental approach to understanding how children cope with disasters. Journal of Child and Adolescent Psychiatric Nursing, 13, 7–16. https://doi.org/10.1111/j.1744-6171.2000.tb00070.x
DeVries, G. J, & Olff, M. (2009). The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. Journal of Traumatic Stress, 22, 259–267. https://doi.org/10.1002/jts.20429
Du, J., Diao, H., Zhou, X., Zhang, C., Chen, Y., Gao, Y., & Wang, Y. (2022). Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. Medical Review, 2, 219–243. https://doi.org/10.1515/mr-2022-0012
Dyregrov, A., & Yule, W. A. (2006). A review of PTSD in children. Child and Adolescent Mental Health, 11, 176–184. https://doi.org/10.1111/j.1475-3588.2005.00384.x
Elia, J. (2023). Acute and posttraumatic stress disorders (ASD and PTSD) in children and adolescents. MSD Manuals.
Elklit, A., & Petersen, T. (2008). Exposure to traumatic events among adolescents in four nations. Torture, 18, 2–11.
Fernandez, L., Aulagnier, M., Bonnet, A., Guinard, A., Pedinielli, J. L., & Préau, M. (2005). Module VI: Outils psychométriques [Module VI: Psychometric tools]. In P. Verger, M. Aulagnier, V. Schwoebel, & T. Lang (Eds.), Démarches épidémiologiques après une catastrophe [Epidemiological procedures following a disaster] (pp. 201–204). La Documentation Française.
Fox, V., Dalman, C., Dal, H., Hollander, A. C., Kirkbride, J. B., & Pitman, A. (2021). Suicide risk in people with post-traumatic stress disorder: a cohort study of 3.1 million people in Sweden. Journal of Affective Disorders, 15, 609–616. https://doi.org/10.1016/j.jad.2020.10.009
Halaly, S., Auf, A. I., Mohammed, M. A. A., Mouhammed, A. A., Albasheer, R. A., Alrahman, W. A. A., & Osman, A. H. (2024). Assessing the prevalence of post-traumatic stress disorder and its risk factors among adult internally displaced persons in Sudan. Journal of Advances in Medicine and Medical Research, 36, 337–347. https://doi.org/10.9734/jammr/2024/v36i75508
Hicks, E. M., Niarchou, M., Goleva, S., Kabir, D., Johnson, J., Johnston, K. J. A., Ciarcia, J., Pathak, G. A., Smoller, J. W., Davis, L. K., Nievergelt, C. M., Koenen, K. C., Huckins, L. M., & Choi, K. W. (2024). Comorbidity profiles of posttraumatic stress disorder across the medical phenome. Biological Psychiatry Global Open Science, 4, 100337. https://doi.org/10.1016/j.bpsgos.2024.100337
Hodges, M., Godbout, N., Briere, J., Lanktree, C., Gilbert, A., & Kletzka, N. (2013). Cumulative trauma and symptom complexity in children: a path analysis. Child Abuse & Neglect, 37, 891–898. https://doi.org/10.1016/j.chiabu.2013.04.001
Jannini, T. B., Longo, L., Rossi, R., Niolu, C., Siracusano, A., & Di Lorenzo, G. (2023). Complex posttraumatic stress disorder (cPTSD) and suicide risk: a multigroup mediation analysis exploring the role of post-traumatic symptomatology on hopelessness. Journal of Psychiatric Research, 165, 165–169. https://doi.org/10.1016/j.jpsychires.2023.07.032
Josse, E. (2011). Le traumatisme psychique: Chez le nourrisson, l’enfant et l’adolescent [Psychological trauma: In infants, children and adolescents]. De Boeck Superieur.
Kassam-Adams, N., Garcia-Espana, J. F., Miller, V. A., & Winston, F. (2006). Parent-child agreement regarding children’s acute stress: The role of parent acute stress reactions. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1485–1493. https://doi.org/10.1097/01.chi.0000237703.97518.12
Kerig, P. K., & Becker, S. P. (2010). From internalizing to externalizing: Theoretical models of the processes linking PTSD to juvenile delinquency. In S. J. Egan (Ed.), Posttraumatic stress disorder (PTSD): Causes, symptoms and treatment (pp. 33–78). Nova Science Publishers.
Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry, 171, 864-871. https://doi.org/10.1176/appi.ajp.2014.13081132
Kihas, I., Barrett, E. L., Teesson, M., Touyz, E. L., Newton, N. C., & Mills, K. L. (2024). Co-occurring experiences of traumatic events and substance use among young people. Child Abuse & Neglect, 156, 107003. https://doi.org/10.1016/j.chiabu.2024.107003
Konrad, K., Kohls, G., Baumann, S., Bernhard, A., Martinelli, A., Ackermann, K., Smaragdi, A., Gonzalez-Madruga, K., Wells, A., Rogers, J. C., Pauli, R., Clanton, R., Baker, R., Kersten, L., Prätzlich, M., Oldenhof, H., Jansen, L., Kleeven, A., Bigorra, A., Hervas, A., … Freitag, C. M. (2022). Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder. Journal of Child Psychology and Psychiatry, 63, 218–228. https://doi.org/10.1111/jcpp.13428
Korte, K. J., Jiang, T., Koenen, K. C., Galea, S., & Gradus, J. L. (2021). Epidemiology of trauma and PTSD in adults. In M. J. Friedman, P. P. Schnurr, & T. M. Keane (Eds.), Handbook of PTSD: Science and practice (3rd ed., pp. 61–75). The Guilford Press.
Koslouski, J. B., Stark, K., & Chafouleas, S. M. (2023). Understanding and responding to the effects of trauma in the classroom: a primer for educators. Social and Emotional Learning: Research, Practice, and Policy, 1, 100004. https://doi.org/10.1016/j.sel.2023.100004
Mbwayo, A. W, Mathai, M., Harder, V.S., Nicodimos, S., & Vander-Stoep, A. (2019). Trauma among Kenyan school children in urban and rural settings: PTSD prevalence and correlates. Journal of Child & Adolescent Trauma, 13, 63–73. https://doi.org/10.1007/s40653-019-00256-2
Meiser-Stedman, R., Smith, P., Glucksman. E., Yule, W., & Dalgleish, T. (2007). Parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma. Journal of Abnormal Child Psychology, 35, 191–201. https://doi.org/10.1007/s10802-006-9068-1
Melese, M., Maru, L., & Esubalew, D. (2024). Posttraumatic stress disorder and its associated factors among people living in Dabat district, northwest Ethiopia. Frontiers in Psychiatry, 15, 1359382. https://doi.org/10.3389/fpsyt.2024.1359382
Nixon, R. D., Nishith, P., & Resick, P. A. (2004). The accumulative effect of trauma exposure on short-term and delayed verbal memory in a treatment-seeking sample of female rape victims. Journal of Traumatic Stress, 17, 31–35. https://doi.org/10.1023/B:JOTS.0000014673.02925.db
Nooner, K. B., Linares, L. O., Batinjane, J., Kramer, R. A., Silva, R., & Cloitre, M. (2012). Factors related to posttraumatic stress disorder in adolescence. Trauma, Violence & Abuse, 13, 153–166. https://doi.org/10.1177/1524838012447698
Novotney, A. (2024, March 6). Women who experience trauma are twice as likely as men to develop PTSD. Here’s why. American Psychological Association. Retrieved from https://www.apa.org/topics/women-girls/women-trauma
Pederson, C. L., Maurer, S.H., & Kaminski, P. L. (2004). Hippocampal volume and memory performance in a community-based sample of women with posttraumatic stress disorder secondary to child abuse. Journal of Traumatic Stress, 17, 37–40. https://doi.org/10.1023/B:JOTS.0000014674.84517.46
Phung, B. (2022). Potential challenges and future implications for trauma-informed approaches in schools. Frontiers in Education, 7, 1040980. https://doi.org/10.3389/feduc.2022.1040980
Rabie, M. A., El-Sheikh, M., ElSayed, M., Fekry, M., & Saad, M. (2015). Post-traumatic stress disorder and psychiatric comorbidity in a sample of Egyptian adolescents after the revolution: a crosssectional study. Middle East Current Psychiatry, 22, 91–96. https://doi.org/10.1097/01.XME.0000461324.86909.c1
Sanger, B. D., Alarachi, A., McNeely, H. E., McKinnon, M. C., & McCabe, R. E. (2025). Brain fog and cognitive dysfunction in posttraumatic stress disorder: an evidence-based review. Psychology Research and Behavior Management, 18, 589–606. https://doi.org/10.2147/PRBM.S461173
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press.
Stuber, J., Galea, S., Pfefferbaum, B., Vandivere, S., Moore, K., & Fairbrother, G. (2005). Behavior problems in New York City’s children after the September 11, 2001, terrorist attacks. American Journal of Orthopsychiatry, 75, 190–200. https://doi.org/10.1037/0002-9432.75.2.190
Tamir, T. T., Tekeba, B., Mekonen, E. G., Gebrehana, D. A., & Zegeye, A. F. (2025). Shadows of trauma: an umbrella review of the prevalence and risk factors of post-traumatic stress disorder in children and adolescents. Child and Adolescent Psychiatry and Mental Health, 19, 48. https://doi.org/10.1186/s13034-025-00879-4
Tuicomepee, A., & Romano, J. L. (2008). Thai adolescent survivors 1 year after the 2004 tsunami: a mixed methods study. Journal of Counseling Psychology, 55, 308–318. https://doi.org/10.1037/0022-0167.55.3.308
Vila, G., & Bertrand, C. (2003). Exposition de l’enfant au facteur traumatique et réactions parentales. Analyse des interactions et modélisation [Child exposure to the traumatic factor and parental reactions. Analysis of interactions and modeling]. Stress et Trauma, 3, 89–91.
Walter, K. H., Levine, J. A., Madra, N. J., Beltran, J. L., Glassman, L. H., & Thomsen, C. J. (2022). Gender differences in disorders comorbid with posttraumatic stress disorder among U.S. sailors and marines. Journal of Traumatic Stress, 35, 988–998. https://doi.org/10.1002/jts.22807
Wamser-Nanney, R., & Cherry K. E. (2018). Children’s trauma-related symptoms following complex trauma exposure: Evidence of gender differences. Child Abuse & Neglect, 77, 188–197. https://doi.org/10.1016/j.chiabu.2018.01.009
Wang, S. K., Feng, M., Fang, Y., Lv, L., Sun, G. L., Yang, S. L., Guo, P., Cheng, S. F., Qian, M. C., & Chen, H. X. (2023). Psychological trauma, posttraumatic stress disorder and trauma-related depression: a mini-review. World Journal of Psychiatry, 13, 331–339. https://doi.org/10.5498/wjp.v13.i6.331
Xiang, A. H., Martinez, M. P., Chow, T., Christensen, M. L., Nguyen, A., Duffy, E. Y., Dyer, W., Cummings, C., Beckman, J. A., Tran, N., Young, D. R., Nhan, L. A., Ma, W., Hale, C., Li, Y., Subramaniam, V., Kim, H., Wu, D., Chou, C. P., Liu, C. H., … Nguyen, K. (2024). Depression and anxiety among US children and young adults. JAMA Network Open, 7, e2436906. https://doi.org/10.1001/jamanetworkopen.2024.36906
Zhao, L., Wang, H., Wang, K., Shen, C., & Tao, M. (2024). Study on the relationship between PTSD and academic control and academic emotion in primary and middle school students after flood disaster. Frontiers in Psychology, 15, 1429238. https://doi.org/10.3389/fpsyg.2024.1429238
Uniwersyteckie Czasopisma Naukowe